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PROOF OF INSURANCE (2021 - 2021) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 08/06/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Gary E. Krouse Insurance Services, Inc. 9620 Topanga Canyon Place, Unit H Chatsworth, CA 91311 'hone No. (818) 407-5300 -...--------------- -- -- INSURED EL SEGUNDO ART WALK, LLC 142 RICHMOND ST El Segundo, CA 90245 COVERAGES CERTIFICATE NUMBER:912204 AFFORDING COVERAGE I NAIC# REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ..........TYPE OF INSURANCE ........ NUMBER .... ............. .. POLICY INSµ AODL '$[DtiFRI Y ,......... ,.v.... _._._._._ _._._._._ ........ _ .. POLICY EFF POLICY E7(P LIMITS � MMJDOdYYYY � MMADD MMERCIAL GENERAL LIABILITY ZAI CO FLM 1216811 _00 08/27/2021 08/29/2021 EACH OCCURRENCE $-- 1 O0O QQQ CLAIMS -MADE OCCUR �( `tY{YhAk�d�'7Ci fiL=Nt`Ei`f i $ ,PREMISES (E ocrur5enre,1 - --100 QQ!} dti HOSt LIgUOr EXP (Any one person) �, $ 5 0Q0_ µ�y,,,rr, _______„ LigUOr (1,.OtSO OOOA;g, POCC „MED $ 1 PERSONAL&ADV INJURY Q0O000 GFUTA ENLAGGREGATELIMITAPPLIESPER: GENERALAGGREGATE 2,,000,000 POLICY E PR'�, LOC _� PRODUCTS - COMP/OP AGG J $ 1,000, 000, JECT -- I $ OTHER; AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT xader�Ea $ — ----- ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident)HIRED $ '----- NON -OWNED �_LP r�a�d ddt„op@�` GF AUTOS ONLY AUTOS ONLY .._ f ................ .... Is GL � X OCCUR SXS1190211-00 08/27/2021 08/29/2021 RENCE � �� EXCESS L.IAB� C,LAIMS MADE 16 AGGREGATE $.. „ DED RETENTION $ $ WORKERS COMPENSATION PER STATUTE �. OERH ECUTIVE Y❑ CDEA NIA ..E EXAND CLUDED? OF IC(ManBERIMEMBEatory in EIRANYPROPRIETOR/ L D SEASE EMPLOYEEI $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ I Inland Marine FLM1216811-00 08/27/2021 08/29/2021 See Attached DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES Coverage Location: United States &Canada Event: EL SEGUNDO ART WALK Certificate Holder is named as an Additional Insured and Loss Payee as their interests may appear. 2021 All coverages expire at 12:01 a.m. Standard Time. The actual event dates may be limited. Please review the Scheduled Events form attached to this certificate. (;tK I IHIL;A I L HULULK CITY OF EL SEGUNDO 350 MAIN STREET EL SEGUNDO, CA 90245 United States Of America Fax No. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD This certificate of insurance does not affirmatively or negatively amend, extend, or alter the coverage afforded by the insurance policy. .._.................................. DATE (MMOD") ADDITIONAL COVERAGE DETAILS 08/06/2021 INSURED EL SEGUNDO ART WALK, LLC The following is attached to and made part of certificate number 912204. Policy Details Coverage Limit Deductible Inland Marine Company: Zurich American Insurance Company Policy Number: FLM1216811-00 *Period: 08/27/2021 - 08/29/2021: 2 Day(s) Equipment, props, sets, wardrobe (rented) 50,000 1,000 Equipment, Props, Sets, Wardrobe (owned) Excluded Rented Furs, Jewelry, Art & Antiques Coverage Excluded Extra Expense Excluded Third Party Property Damage 10,000 1,500 Hired/Non-Owned Physical Damage -Aggregate Excluded Hired/Non-Owned Physical Damage -Per Vehicle Excluded Rental Cost Reimbursement Excluded Waiver of Subrogation Excluded Coverage Extension Endorsement Coverage Extension Endorsement Excluded Terrorism Included General Liability Company: Zurich American Insurance Company Policy Number: FLM1216811-00 *Period: 08/27/2021 - 08/29/2021: 2 Day(s) General Aggregate 2,000,000 Products / Completed Operations 1,000,000 Personal /Advertising Injury 1,000,000 Each Occurrence 1,000,000 Fire Legal 100,000 Medical Payments 5,000 Blanket Additional Insureds (other than city/special certs & Included waivers) City / Other Special Certificates Included Waiver of Subrogation Excluded Host Liquor Included Liquor Liability -Aggregate 1,000,000 Liquor Liability -Each Common Cause Limit 1,000,000 Abuse & Molestation -Aggregate Excluded Abuse & Molestation -Each Claim Excluded Abusive Act Alleged Participant Supplemental Coverage - Excluded Aggregate Abusive Act Alleged Participant Supplemental Coverage - Excluded Occurrence Participant Legal Liability -Aggregate Limit Excluded Participant Legal Liability - Occurrence Limit - Bodily Injury Excluded Participant Legal Liability - Occurrence Limit - Property Damage Excluded Terrorism Included *All coverages expire at 12:01 a.m. Standard Time. i APM-CERT-DETAILS 1009 ........� Certificate Number 912204 Scheduled Events Certificate Number: 912204 Event Type Venue Dates Attendees EL SEGUNDO ART EL SEGUNDO ART WALK LOCATIONS 08/27/2021 - 08/28/2021 at 12:01 am (Setup) 2,000 Participants WALK 2021 212 EUCALYTPUS DR AND PARKING 08/28/2021 - 08/29/2021 at 12:01 am 50 Spectators Art Festivals LOT OF 314 MAIN STREET EL SEGUNDO, CA 90245 ABANEV-SCHD(05/06) Page 1 of 1 SCHEDULE OF FORMS DATE (MMIDD/YY) 08/06/2021 Insured: EL SEGUNDO ART WALK, LLC This Schedule of Forms is attached to and made part of certificate number 912204, as of 08/06/2021 at 12:45 PM PT, and lists the forms included in the policy(s) and subsequent endorsement (s) at the time this certificate was issued. Form # Ed. Name Special Event Package Notices U-GU-319-F 0109 Important Notice - In Witness Clause U-GU-874-A 0611 Notice of Disclosure for Agent and Broker Compensation UGUB73ACW 0611 Disclosure Statement U-GL-1197-A CW 0104 Asbestos Exclusion Endorsement U-GU-1191-ACW 0315 Sanctions Exclusion Endorsement Common UGU727ACW 0806 Commercial Insurance Policy UGUD310A 0193 Common Policy Declarations UGU619ACW 1002 Schedule of Forms and Endorsements UGU621ACW 1002 Schedule Of Named Insured(s) UGU61BACW 1002 Schedule Of Locations IL0017 1198 Common Policy Conditions U-GU-1223-B CA 0916 Revised Definition Of Spouse Endorsement UABI100ACW 0117 Schedule Of Productions UABI101ACW 0117 Definition Of Employee UAB100ACW 0117 Minimum Earned Premium Endorsement ILD270 0720 California Changes - Cancellation and Nonrenewal Endorsement IL0003 0908 Calculation of Premium U-GU-630-ECW 0120 Disclosure of Important Information Relating to Terrorism Risk Insurance Act Inland Marine UABMD104ACW 0117 Commercial Inland Marine Declarations Entertainment Program UGU619ACW 1002 Schedule of Forms and Endorsements CM0001 0904 Commercial Inland Marine Conditions UABM133ACW 0117 Common Conditions, Exclusions And Definitions UABM105ACW 0117 Miscellaneous Equipment Coverage Form UABM106ACW 0117 Props, Sets And Wardrobe Coverage Form UABM109ACW 0117 Third Party Property Damage Coverage Form UABM103ACW 0117 Loss Payable Endorsement UABM12BACW 0117 Excluded Property Endorsement UABM114ACW 0117 Unscheduled Production, Presentation Or Event Exclusion UABM100ACW 0117 Stunt, Animal Exposure And Pyrotechnic Exclusion U-GU-767-BCW 0115 Cap on Losses From Certified Acts of Terrorism General Liability UABLD10OBCW 0119 Commercial General Liability Coverage Part Declarations UGU619ACW 1002 Schedule of Forms and Endorsements UABI110ACW 1020 Schedule of Events CG0001 0413 Commercial General Liability Coverage Form CG2011 1219 Additional Insured - Managers of Lessors of Premises CG2012 1219 Additional Insured - State or Governmental Agency or Subdivision or Political Subdivision - Permits or Authorizations CG2026 1219 Additional Insured - Designated Person or Organization CG2028 1219 Additional Insured - Lessor of leased equipment UABL121ACW 0117 Limited Stationary Aircraft Coverage CG2106 0514 Exclusion -Access or Disclosure of Confidential or Personal Information and Data -Related Liability - With Limited Bodily Injury Exception U-GL-1171-B-CW 0719 Fungi Bacteria Exclusion U-GL-1178-A-CW 0703 Asbestos Exclusion CG2147 1207 Employment Related Practices Exclusion U-GL-1517-BCW 0413 Collection or Distribution of Material or Information in Violation of Law Exclusion UABL131ACW 0117 Non -Performing Animal Exclusion UABL102ACW 0117 Property Damage To Rented Premises Exclusion UABL129ACW 0117 Assault And Battery Exclusion UGL1250ACW 0905 Abusive Act Liability Exclusion UABL122ACW 0117 Newly Acquired Or Formed Entity Exclusion UABL107ACW 0117 Exclusion - Insureds Conducting Media, Entertainment, Or Internet Type Operations UABL130ACW 0117 Informational Content Exclusion UABL135ACW 0117 Media Content Exclusion UABL137ACW 0117 Cross Suits Exclusion UABL138ACW 0117 Personal And Advertising Injury - Exclusion Of False Arrest, Detention, Imprisonment, Libel, Slander, Right Of Privacy, Advertising Idea, And Copyright, Trademark Or Trade Secret UABL106ACW 0117 Unscheduled Production, Presentation Or Event Exclusion UABL103ACW 0117 Stunt, Pyrotechnic And Animal Exposure Exclusion UABL144ACW 1019 Event Conditional Exclusion CG2132 0509 Communicable Disease Exclusion UABL146ACW 1019 Unscheduled Products Exclusion UABL145ACW 1019 Hazardous Activities, Pyrotechnic Activities and Animal Exposure Exclusion UABL147ACW 1019 Loss Arising Out of Participation in a Sports or Athletic Event, Competition, Contest or Exhibition Exclusion UABL143ACW 1019 Moshing Exclusion UABL150ACW 1019 Camping Conditional Exclusion UGLD1036BCW 0904 Liquor Liability Coverage Part Declarations CGO033 0413 Liquor Liability Coverage Form APA-CERT-FORMLIST 0914 Certificate Number: 912204 Page 1 of 2 SCHEDULE OF FORMS DATE (MM/DDIYY) 08/06/2021 Insured: EL SEGUNDO ART WALK, LLC This Schedule of Forms is attached to and made part of certificate number 912204, as of 08/06/2021 at 12:45 PM PT, and lists the forms included in the policy(s) and subsequent endorsement (s) at the time this certificate was issued. Form # Ed. Name IL0021 0908 Nuclear Energy Liability Exclusion Endorsement (Broad Form) UABL105ACW 0117 Commercial General Liability Changes U-GU-767-BCW 0115 Cap on Losses From Certified Acts of Terrorism Excess Liability Policy Excess Liability Notices U-GU-1191-ACW 0315 Sanctions Exclusion Endorsement U-GU-874-A 0611 Notice of Disclosure for Agent and Broker Compensation Forms U-SXS-104-ACW 0911 Straight Excess Liability Policy (jacket) UGU621ACW 1002 Schedule Of Named Insured(s) U-SXS-D-100-ACW 0911 Straight Excess Liability Policy Declarations U-SXS-101-ACW 0911 Schedule of Underlying Insurance U-SXS-103-ACW 0911 Schedule of Forms & Endorsements U-GU-630-ECW 0120 Disclosure of Important Information Relating to Terrorism Risk Insurance Act U-SXS-100-ACW 0911 Straight Excess Liability Policy U-GU-767-BCW 0115 Cap on Losses From Certified Acts of Terrorism U-SXS-117-BCW 0514 Professional Liability Limitation Endorsement U-EXS-115-CCW 0411 Communicable Disease Exclusion UEXS319CCW 0514 Liquor Law Liability And Alcohol Consumption Health Hazards Exclusion UEXS101BCW 0411 Abuse Or Molestation Exclusion UEXS107ACW 0499 Athletic Participants Exclusion U-GU-1223-B CA 0916 Revised Definition Of Spouse Endorsement U-EXS-312-FCW 0514 Exclusion - Recording and Distribution of Material or Information in Violation of Law U-EXS-178-BCA 0411 California Cancellation and Nonrenewal U-SXS-120-A CW 0911 Total Pollution Exclusion with Hostile Fire Exception Disclaimers This Certificate of Liability Insurance includes the Type of Insurance, Limits, and Schedule of Forms in effect as of 08/06/2021 at 12:45 PM PT. It does not affirmatively or negatively amend, extend, or alter the coverage afforded by the insurance policy nor confer any rights upon the certificate holder. You may be required to request an updated certificate in the event of subsequent policy modifications. The information included in this certificate that has been provided by Abacus Insurance Brokers, is for your information only, and does not create a contract or agency relationship between the certificate holder or any insured and Abacus Insurance Brokers. By accepting this certificate the certificate holder acknowledges that Abacus Insurance Brokers is not the agent of the certificate holder or any insured, but is solely the agent of the listed carrier(s). Abacus Insurance Brokers makes no representation whether the coverages listed herein are appropriate for the certificate holder or any insured. Please review the listed coverages carefully and direct any questions to your broker. For a complete listing of coverages, terms, conditions and exclusions, please view the referenced Policy(s). APA-CERT-FORMLIST 0914 Certificate Number: 912204 Page 2 of 2 Date (MM/DDNYYY) Certificate Verification 08/06/2021 Insured: EL SEGUNDO ART WALK, LLC Abacus provides an efficient website lookup tool for certificate holders to verify the authenticity of certificates of insurance. 1. Navigate to the website and input the verification code OR Scan the OR code. 2. The actual certificate issued through the Abacus Platform will download. 3. Compare the details of the downloaded certificate to the certificate presented by the client. "ru'"ebsite Verification Code www.abacus.net/verify-certificate OIOVJPJNVO o About Certificates Issued through the Abacus.net Platform • Abacus requires that all certificates be issued through the Abacus Platform. Certificates issued outside of the Abacus Platform are invalid. • Certificates may be issued through the Abacus Platform by either the named insured (if registered through the Abacus Platform) or their Abacus registered insurance broker. • Certificates with any stray marks, cross outs or alterations of any sort are invalid. • Each certificate is numbered and correlates to the document issued through the Abacus Platform. APA-CERTVER 0917 Certificate Number. 912204 Page 1 of 1 Get your digital proof of insurance & membership card on the AAA App pppp/� 7 Eleclron© roof of insurance may not be valid as proof in alls ales. Please Click keep our hard co pC�ion on hand � st be a current AAA member and insured through AAA to use this feature, Available for iPhone® and smartphones for Android'", Message, data and roaming rates may apply. I w PROOF O_,___..----------------. �...,�.._�._....___.-..___..____. _®,__W_F INSURANCE w Interinsurance Exchange of the Automobile Club cNAIC #: 15598 d Named Insured Policy Number: CAAdQMNMM JOHN MCCULLOUGH Effective Date: 09/17/2020 Expiration Date: 09/17/2021 VEHICLES ON POLICY YEAR MAKE 2015 FORD EXPLORER XLT 2018 TYTA RAV4 LE o DRIVERS ON POLICY 0 MCCULLOUGH, JOHN I MCCULLOUGH, ALISSA ENO VEH t,D, # " " d " " d " r This policy provides at least the minimum amounts of liability insurance I required by the CA VEH CODE SECTION 16056 for the specified vehicles I and named insureds. Coverage subject to policy terms and limits. I...------------------------------ —..........___----..___o..�_____—_.____,------------------ ,_----_----__._—..--- I u u,r. V"(1II lu W A%111:�:�:� A. Kii A r, r 'vi== vfr rju II i!') H ? 9417 ): A GI AIMS H0 r II I1 Uq '1 :,:,800:,:, 7 2:,:,:524.6 After an accident, exchange information with the other party and follow these 5 easy steps: Step 1: Pull vehicle over to a safe place. Get the names, addresses, and phone numbers of all persons involved in the accident, e.g., ui pedestrians, witnesses, other passengers, etc. w Step 2: Take photos of or write down the other person's driver's o license information and other vehicle's license plate number, w including state of registration. Step 3: Take photos of or write down the other person's insurance card information. Step 4: Take photos of the vehicles involved, damages and I surrounding area of the accident, if it is safe to do so, Step 5: Call our AAA Claims Hotline at 800-672-5246 to report the loss. If necessary, we will arrange to have your vehicle towed. Our I provider's tow trucks always display the AAA emblem. Do not admit responsibility for or discuss the circumstances of the accident I with anyone other than the police or an authorized Auto Club claims representative. Do not disclose your policy limits to anyone. i I For questions or changes to your policy, call 1-877-422-2100, Monday through Friday from 7 a.m. to 9 p.m, or Saturday from 8 a.m, to 5 p,m, ------------- _ _ " Place a Proof of Insurance card in each vehicle insured under -you -r policy. Ipolicy. - - M . __ ---------__ n addition, we suggest that each listed driver carry a card. Under California law, Call our AAA Claims drivers and owners of a motor vehicle must be able to show proof of financial Hotline at 1-800-672-5246 responsibility at all times. These cards become invalid and should be destroyed on the expiration or termination date of the policy. -------------------------------------------------------------------------------------------------------------------- I PROOF OF INSURANCE VEHICLES ON POLICY ��� Interinsurance Exchange of the Automobile Club YEAR MAKE VEH I.D. # NAIC #: 15598 2015 FORD EXPLORER XLT d " ��` 2018 TYTA RAV4 LE d r r Named Insured Policy Number: CAAdkJohNo JOHN MCCULLOUGH { w I w r, x DRIVERS ON POLICY 0 MCCULLOUGH, JOHN I Effective Date: 09/17/2020 Expiration Date: 09/17/2021 I MCCULLOUGH, ALISSA ENO d " I This policy provides at least the minimum amounts of liability insurance I required by the CA VEH CODE SECTION 16056 for the specified vehicles and named insureds. Coverage subject to policy terms and limits. I I I::::: YO L) FIAVE AN AC C U I' IE=' I' °III'° C II,,. II,,. O U IFZ 17' AAA C Ili MIMS IH1101" IV,,, II N 1:.11.. 11,, 800 ,.d 7 ,, 5246 After an accident, exchange information with the other party and follow these 5 easy steps: dStep 1: Pull vehicle over to a safe place. Get the names, addresses, , I and phone numbers of all persons involved in the accident, e.g., w pedestrians, witnesses, other passengers, etc. w Step 2: Take photos of or write down the other person's driver's d license information and other vehicle's license plate number, LL 0 pincluding state of registration. d " I Step 3: Take photos of or write down the other person's insurance I card information. r Step 4: Take photos of the vehicles involved, damages and surrounding area of the accident, if it is safe to do so. Step 5: Call our AAA Claims Hotline at 800-672-5246 to report the loss. If necessary, we will arrange to have your vehicle towed. Our provider's tow trucks always display the AAA emblem. Do not admit responsibility for or discuss the circumstances of the accident with anyone other than the police or an authorized Auto Club claims representative. Do not disclose your policy limits to anyone„ I For questions or changes to your policy, call 1-877-422-2100, Monday through Friday from 7 a.m. to 9 p.m, or Saturday from 8 a.m. to 5 p,m. l 8165 (2121) DBW21